Authorities in Texas have reported the first-ever transmission of Ebola in the U.S., which health officials say occurred due to a “breach of protocol” during the treatment of Ebola patient Thomas Eric Duncan at Texas Health Presbyterian Hospital.
The Texas health care worker who contracted Ebola after providing care for an infected patient likely breached safety protocols, health officials said Sunday.
“Certainly there has to have been an inadvertent, innocent breach of the protocol of taking care of the patient within the personal protective equipment — that extremely rarely happens,” Dr. Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases, told Martha Raddatz on ABC’s “This Week” Sunday. “We’ve been taking care of Ebola patients since 1976. Groups like Doctors Without Borders who do that almost never have an infection, because of the experience of doing this.”
The infected worker, identified as a female nurse but not named by authorities as they announced the case on Sunday, is believed to be the first person to contract the disease in the United States. The nurse helped care for Thomas Eric Duncan, a Liberian man who died on Wednesday after being exposed to Ebola in his home country and developing the disease while visiting the United States.
According to officials at Texas Health Presbyterian Hospital, the nurse wore full protective gear — a mask, gloves, and gown —when she came into contact with Duncan. But the director of the Centers for Disease Control and Prevention (CDC said today that the new case is indicative of a professional lapse that may have caused other health workers at the hospital to also be infected.
“We don’t know what occurred in the care of the index patient, the original patient, in Dallas, but at some point there was a breach in protocol, and that breach in protocol resulted in this infection,” CDC director Dr. Thomas Frieden said at a Sunday news conference. “We are evaluating other potential healthcare worker exposures because if this individual was exposed, which they were, it is possible that other individuals were exposed,” he said.
CDC is ‘deeply concerned’ about the incident
The Texas Health Presbyterian Hospital worker reported “a low-grade fever” Friday, the Texas Department of State Health Services said in a statement. This person “was isolated and referred for testing.” The preliminary test result was received late Saturday. Confirmatory testing at CDC is expected to be completed late Sunday, Dr. Frieden said.
If confirmed by the CDC, the nurse’s case would mark the first known transmission of Ebola in the United States and the second-ever diagnosis in the country. At least one person who may have had contact with the infected health worker when she could possible transmit the virus has been proactively placed in isolation and is being monitored; 18 other “casual contacts” have been identified and will also be monitored for any signs of the disease, officials said.
Health care workers at Texas Health Presbyterian Hospital, where the first case of Ebola contracted on U.S. soil was reported on Sunday.
“We knew a second case could be a reality, and we’ve been preparing for this possibility,” Texas Health Commissioner David Lakey said in a statement. “We are broadening our team in Dallas and working with extreme diligence to prevent further spread.”
During an appearance on CBS’ “Face the Nation,” Dr. Frieden told moderator Bob Schieffer that the CDC was “deeply concerned” about the incident but stressed that the protocols for the care of Ebola patients are safe if done properly.”I think the fact that we don’t know of a breach in protocol is concerning, because clearly there was a breach in protocol. We have the ability to prevent a spread in Ebola,” said Dr. Frieden.
‘Even a single breach can result in contamination’
Dr. Frieden cited four steps being taken by the CDC: ensuring the woman is cared for safely; identifying her contacts; treating all health care workers who cared for Duncan as having potentially been exposed; and reviewing procedures used to protect health care workers who treat Ebola patients.
“We know from many years of experience that it’s possible to care for patients with Ebola safely, without risk to health care workers,” he said. “But even a single breach can result in contamination.”
It is possible that the health care worker, who had “extensive contact” with Duncan, may have improperly taken off her protective gear or contracted the disease while performing one of several invasive procedures on Duncan, Dr. Frieden said. After the CDC reviews the incident and determines the mode of transmission, the agency will then “fortify” the protocol to make sure it is followed, he added.
While it is not yet known exactly how or when the nurse was infected, CDC officials say it is possible she accidentally touched contaminated material when removing her protective gear.
“This tells us there is a need to enhance training and to make sure protocols are followed,” he said. He added the CDC will study ways to reduce the number of health care workers involved in treatment, to reduce medical procedures — noting that kidney dialysis, for example, could increase risk — and to provide on-site monitoring to ensure that protocols are followed.
Dr. Frieden also said the CDC is considering having Ebola patients be treated at one of the four facilities in the United States that have special isolation units. Three of them — the National Institutes of Health in Bethesda, Md.; Emory University Hospital in Atlanta; and the University of Nebraska Medical Center — have treated confirmed or suspected Ebola cases. The fourth place is St. Patrick Hospital in Missoula, Mont.
New case poses little risk to the general public
Despite the alarming breach of protocol, health officials stressed that the general public is not at risk. Mike Rawlings, the mayor of Dallas, addressed likely public fears brought about by the second case, saying that authorities had taken the necessary steps to protect the community. “We heard about this around midnight and have been working throughout the morning to make sure the citizens of Dallas are safe when they wake up. I believe I can say they are.”
Rawlings detailed protective measures taken by the city, including the Dallas fire and rescue haz-mat team “clearing up and decontaminating any of the open areas of an apartment complex” and “standing by to make sure nobody enters that apartment complex”. Furthermore, he said, “we have knocked on every door in that block and talked to every person who came to the door to explain what has happened and what we have done.”
Hazmat crews are seen cleaning the nurse’s Dallas-area apartment. Local officials say the new case does not pose a risk to the general public, as the nurse was quickly admitted to the hospital and isolated.
The White House said President Obama had discussed the news with Health and Human Services Secretary Sylvia Burwell, directing that the CDC “investigation into the apparent breach in infection control protocols at the Dallas hospital move as expeditiously as possible.”
The Ebola epidemic has killed more than 4,000 people in West Africa, the vast majority of them in Liberia, Guinea and Sierra Leone. In the U.S., tougher screening for Ebola began Saturday at New York’s Kennedy Airport, where federal Homeland Security officials began screening travelers from those nations, taking their temperature and observing them for other Ebola symptoms.
This latest news out of Texas underscores a brutal reality of Ebola: The disease is terribly virulent. At the same time, it’s a reminder that those who are most at risk for contracting Ebola are the individuals who have closest contact with Ebola patients: Family members, and the caregivers who treat them.